Healthcare Provider Details

I. General information

NPI: 1134169782
Provider Name (Legal Business Name): KRISTIN STILES GREEN ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTIN STILES GREEN ND

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 11/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 W JANSS RD #135
THOUSAND OAKS CA
91360
US

IV. Provider business mailing address

227 W JANSS RD #135
THOUSAND OAKS CA
91360
US

V. Phone/Fax

Practice location:
  • Phone: 805-373-2890
  • Fax: 805-364-5464
Mailing address:
  • Phone: 805-373-2890
  • Fax: 805-364-5464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License NumberND-110
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND 110
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: